1. Field of the Invention
The present invention relates to endoscopic surgical instruments. In particular, the present invention relates to an apparatus for sealing the opening of an endoscopic suction/irrigation valve assembly and probe through which auxiliary endoscopic surgical instruments are inserted. The apparatus provides a shaft sealing surface which also slidably, yet frictionally grips the shaft of an instrument inserted therethrough thereby holding the instrument tool at a desired position relative to the tip of the suction/irrigation probe.
2. Background Art
Endoscopic surgical procedures are rapidly replacing conventional surgical techniques in a variety of applications. Diagnostic or therapeutic endoscopy procedures are generally preferred because they reduce trauma, decrease the risk of infection at incision sites and decrease patient recovery times. Arthroscopy procedures, for example, have all but replaced arthrotomy approaches for joint repair. Likewise, laparoscopic surgery is rapidly becoming the method of choice for a variety of abdominal procedures that once required large laparotomy incisions.
The laparoscope allows the surgeon to perform surgery within the abdomen by providing visualization of an internalized surgical field. The laparoscope and related instruments are usually introduced into the abdomen through a self-sealing cannula introduced into the abdomen via a small incision or trocharized opening in the abdominal wall. These small openings are generally sealed around the cannula during the procedure, thereby preventing airborne contamination of the surgical field and escape of insufflation gases. After surgery, the incision sites are easily closed and usually heal quickly with minimal scarring.
The growing popularity of laparoscopic surgery and the continuing development of new laparoscopic surgical techniques has created a need for specialized surgical instruments. As a result, many surgical instruments have been designed to meet the special needs of the laparoscopic surgeon. Most of these instruments, by necessity, contain certain basic design similarities. For example, in instruments which are comprised of a tool with an articulated member which must be actuated by means located on a handle, the handle is usually connected to the surgical tool via an elongated hollow shaft which contains an actuating rod connecting the tool and actuating means. This elongated shaft design allows the surgical tool to be introduced into the abdomen through the cannula while allowing the surgeon to operate the tool via the actuating means on the handle from a point external of the abdomen. Examples of such instruments include various retractors, hemostats, tissue clamps, needle holders, and the like. Likewise, the tool end of other instruments such as electrocautery electrodes, scalpels, and blunt dissection probes must be connected to the handle via an elongated shaft to enable delivery of the tool to the surgical site.
The need for irrigating and suctioning of the surgical site during surgery led to the development of the endoscopic suction/irrigation probe. This probe is generally a hollow elongated tube, open at both ends, through which irrigation fluid is applied to and suctioned away from the operative site. Typically, the proximal end of the tube is connected to a valve assembly which allows selective operation of an irrigation pump or suctioning vacuum.
Recently, both disposable and non-disposable suction/irrigation probe valve assemblies have been designed which permit an auxiliary instrument, e.g., an electrocautery electrode, to be introduced through the probe via an opening in the valve assembly. When not in use, the opening through which the instruments are introduced is typically sealed with a threaded cap which is screwed into the open end. Instruments which are introduced into the probe normally have a stationary collar positioned on the shaft near the proximal end which is threaded complimentary to the opening on the valve assembly. The collar is positioned on the shaft so that, when inserted into the opening, the instrument tool extends through the distal end of the probe and is exposed at the operative site. Examples of such devices include the NEZFLAT-DORSEY.RTM. HYDRO-DISSECTION.RTM. system developed by American Hydro-Surgical Instruments, Inc. of Delray Beach, Fla.; and the CORSON.RTM. Disposable Suction/Irrigation Probe developed by Cabot Medical Corporation of Langhorne, Pa.
Several major problems exist with this type of suction/irrigation probe and valve assembly design. First, the surgeon must manually remove the screw cap on the valve assembly which seals the auxiliary instrument opening before placing an instrument into the probe. When the cap is removed, the seal of the opening on the valve assembly is lost. This results in a loss of insufflation gases and allows potentially contaminated bodily fluids to escape through the opening under pressure, often directly into the face of the surgeon. The surgeon must quickly re-cap the opening on the valve assembly or screw an auxiliary instrument into the opening to reestablish a seal.
Second, because the threaded collar is secured to the instrument shaft in a fixed position, the surgeon cannot withdraw the instrument tool from the operative site without either unscrewing the instrument or removing the entire probe. Moreover, the probe cannot be utilized for irrigation or suction until the instrument is unscrewed and removed from the valve assembly and the probe.
Third, instruments cannot be interchanged without the time consuming process of unscrewing and removing the first instrument and replacing and screwing in the other instrument. Each time an instrument is interchanged, the seal of the opening on the valve assembly is broken allowing insufflation gases and potentially contaminated bodily fluid to exit the opening under pressure.
A threaded non-disposable Tabb insert has been developed by Cabot Medical Corporation for adaption to the CORSON.RTM. probe to permit introduction of auxiliary instruments into the probe. This insert has several disadvantages, however. First, the probe has to be removed from the operative site before the insert can be applied. Second, the insert does not seal the opening on the valve assembly when there is no instrument inserted through the insert. Therefore, an instrument must either be continually left in the probe or the probe must be withdrawn for replacement of the cap to maintain a seal of the rear opening. Third, the single seal on the collar of the insert often does not adequately seal in the pressurized insufflation gas and irrigating fluids. Therefore, potentially contaminated bodily fluid can squirt around the edges of the seal directly at the surgeon. Fourth, the Cabot insert is non-disposable and is limited in size to 3 mm auxiliary instruments, thereby requiring specially created electrodes and other instruments for use with the insert.
Therefore, there still exists a need in the art for an apparatus which can be easily adapted to the opening on an endoscopic irrigation/suction valve assembly which 1) seals the auxiliary instrument opening when not in use, 2) permits instruments to be easily introduced and/or interchanged while substantially maintaining a seal of the opening during the interchange, 3) adequately seals external surface of the instrument shaft to seal in insufflation gas and irrigation fluid, 4) frictionally yet slidably grips the instrument shaft so as to allow positioning of the instrument tool at any desired location relative to the distal tip of the probe, 5) allows the surgeon to utilize the handle of the valve assembly to maneuver the combination of probe and auxiliary instrument as a single entity, 6) allows use of the irrigation/suctioning capabilities of the probe while an auxiliary instrument is still inserted in the probe, and 7) can be utilized with disposable or non-disposable suction/irrigation probes.